NPIMap

Individual provider Active NPI

Suraj Jose Menachery, M.D.

  • Surgery Physician
  • Lawrenceville, GA
National Provider Identifier
1174583470
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
057892 Issued in GA
Practice address
631 Professional Dr Ste 300
Lawrenceville, GA 30046-3371
Phone
(770) 962-9977
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 057892 GA Primary

Addresses

Primary practice location

631 Professional Dr Ste 300
Lawrenceville, GA 30046-3371

Mailing address

631 Professional Dr Ste 300
Lawrenceville, GA 30046-3371
Phone (770) 962-9977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061004000326 GA Practitioner - General Surgery 9032198247 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1700 Hospital S Dr
Suite 202
Austell, GA 30106-8116
Phone (770) 944-7818

Hospital & facility affiliations

  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
  • Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
  • Wellstar Douglas Medical Center Hospital, Douglasville, GA, CCN 110184

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Oct 30, 2017 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Piedmont Healthcare Inc CurrentSince Apr 1, 2012 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Surgical Associates, LLC Surgery Past Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients
North Atlanta Surgical Associates Surgery Past Accepting new patients
DHP of Maryland PC Surgery Past Accepting new patients
Delphi Healthcare Specialists of Georgia, LLC Surgery Past Accepting new patients
Gwinnett Clinic LTD Past Accepting new patients
Delphi Healthcare Partners of Maryland LLC Surgery Past Accepting new patients

Locations

1984 Peachtree Rd NW
Ste 205
Atlanta, GA 30309

1700 Hospital South Dr
Ste 202
Austell, GA 30106
Phone (770) 793-7440

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Interoperability endpoints

  • Direct secure messaging: smenachery144657@directwellstar.org

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1174583470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DR STE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463371",
            "telephone_number": "770-962-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DR STE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463371",
            "telephone_number": "770-962-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENACHERY",
        "first_name": "SURAJ",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "057892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.